Provider Demographics
NPI:1891024071
Name:HOLLIE HUYNH OD, INC
Entity Type:Organization
Organization Name:HOLLIE HUYNH OD, INC
Other - Org Name:EASTGATE OPTOMETRY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-373-2020
Mailing Address - Street 1:11893 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1236
Mailing Address - Country:US
Mailing Address - Phone:714-373-2020
Mailing Address - Fax:714-373-2015
Practice Address - Street 1:11893 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1236
Practice Address - Country:US
Practice Address - Phone:714-373-2020
Practice Address - Fax:714-373-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12586T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891024071Medicaid
CA6368290001Medicare NSC
CAEV119AMedicare PIN
CA1891024071Medicaid